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Published on: April 17, 2020
Multicentre Retrospective Analysis of Lung Function Impairment and Risks for Restrictive Syndrome During Childhood
Jeanne Goulin1, Thomas Brigly2, Rony Sfeir3
1UMPCP, University Hospital Centre, Angers, France.
Insights
Neonatal conditions, not surgical factors, are linked to restrictive lung impairment after esophageal atresia repair. Birth weight, ethnicity, heart defects, tracheomalacia, and GERD increase risk in children.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Congenital Anomalies
Background:
- Esophageal atresia (EA) repair can lead to long-term respiratory complications.
- Restrictive ventilatory impairment is a significant concern in children post-EA surgery.
Purpose of the Study:
- To identify factors contributing to restrictive ventilatory impairment in children following type III esophageal atresia repair.
- To differentiate between patient-associated, healthcare-associated, and surgical factors influencing lung function.
Main Methods:
- A multicenter, retrospective national cohort study of 503 patients undergoing EA repair (2008-2013).
- Pulmonary function tests (PFTs) analyzed to compare restrictive impairment vs. normal lung function.
- Logistic regression used to determine risk factors for restrictive syndrome.
Main Results:
- Of 216 patients with interpretable PFTs, 26.9% showed pure restriction.
- Patient factors associated with restriction: lower birth weight, Caucasian ethnicity, neonatal heart defects, tracheomalacia, and GERD.
- Healthcare factor: respiratory crisis treatment; surgical factors and chest wall deformities were not associated with restriction.
Conclusions:
- Neonatal conditions associated with esophageal atresia, rather than surgical factors or chest deformities, are linked to childhood restrictive lung patterns.
- Further prospective studies are necessary to validate these findings and inform clinical management.
Objectives:
To identify the factors that result in a restrictive ventilatory impairment during childhood following type III esophageal atresia (EA) repair.
Study Design:
A multicentre, retrospective, national cohort study was conducted on 503 patients who had undergone surgery for EA between 2008 and 2013. The results of pulmonary function tests (PFT) performed during childhood were used to compare patients with pure restrictive lung impairment to children with normal PFT. Subsequently, logistic regression was employed to ascertain potential risk factors for restrictive syndrome in type III EA.
Results:
The cohort comprised 503 patients, of whom 216 (42.9 %) had interpretable PFT. Among them, 63.4 % exhibited normal results, 26.9 % pure restriction, 5.1 % pure obstruction, and 4.6 % a mixed pattern. Patient-associated factors that were associated with a restrictive impairment were birth weight, Caucasian ethnicity (odds ratio (OR) 4.3 [1.2-15.4]), and the presence of neonatal heart defects (OR = 5.8). [1.9-16.9]), tracheomalacia (OR = 4.1 [1.6-10.2]) and neonatal GERD (OR = 3.1 [1.3-7.4]). The sole healthcare-associated factor was the use of respiratory crisis treatment during childhood (OR = 4.8 [1.3-18.0]), whereas neither surgical factor nor postoperative parietal thoracic deformity was associated with restriction.
Conclusion:
In contrast to surgical approaches or chest wall abnormalities, neonatal EA-associated conditions appear to be associated with a restrictive pattern during childhood, but further prospective studies remain mandatory to validate these results.
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